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<h1 class="titleH1"><span class="inner">エントリー</span></h1>

{*
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ページの概要文ページの概要文ページの概要文ページの概要文ページの概要文ページの概要文
ページの概要文ページの概要文ページの概要文ページの概要文ページの概要文ページの概要文
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<h2 class="titleH2"><span class="inner">エントリー</span></h2>
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<ul>
<li>ダミーダミーダミーダミーダミーダミー</li>
</ul>
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*}

<div class="paragraphBox">
{*<h3 class="titleH3"><span class="inner">エントリー</span></h3>*}
{if $errorMsg}
<div class="txtListBox errorText">
<ul>
{foreach from=$errorMsg item=err}
<li>{$err}</li>
{/foreach}
</ul>
</div>
{/if}
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<ul>
<li>ファイル送信等ができない場合は、郵送にてご応募ください。&nbsp;<a href="/campaigngirl2012/guideline/index.html" target="_blank">詳細はこちら</a></li>
</ul>
<br />
<form name="campaigngirlForm" id="campaigngirlForm" action="/inquiry/campaigngirl2012/confirm/" method="post" enctype="multipart/form-data">
<table>
<tr>
<th>氏名</th><td><input type="text" name="Name" id="Name" maxlength="50" value="{$Name}" class="inputText" style="ime-mode:active;" /></td>
</tr>
<tr>
<th>フリガナ</th><td><input type="text" name="Kana" id="Kana" maxlength="50" value="{$Kana}" class="inputText" style="ime-mode:active;" /></td>
</tr>
<tr>
<th>住所</th><td>
	〒&nbsp;<input type="text" name="Zip1" id="Zip1" maxlength="3" value="{$Zip1}" class="inputNum" style="ime-mode:disabled;" />&nbsp;-&nbsp;<input type="text" name="Zip2" id="Zip2" maxlength="4" value="{$Zip2}" class="inputNum" style="ime-mode:disabled;" />&nbsp;&nbsp;
	<span style="line-height:20px;">都道府県</spsn>&nbsp;<select name="PrefCd" id="PrefCd">
		<option value="00" {if $PrefCd == "00" }selected {/if}>選択して下さい</option>
		<option value="01" {if $PrefCd == "01" }selected {/if}>北海道</option>
		<option value="02" {if $PrefCd == "02" }selected {/if}>青森県</option>
		<option value="03" {if $PrefCd == "03" }selected {/if}>岩手県</option>
		<option value="04" {if $PrefCd == "04" }selected {/if}>宮城県</option>
		<option value="05" {if $PrefCd == "05" }selected {/if}>秋田県</option>
		<option value="06" {if $PrefCd == "06" }selected {/if}>山形県</option>
		<option value="07" {if $PrefCd == "07" }selected {/if}>福島県</option>
		<option value="08" {if $PrefCd == "08" }selected {/if}>茨城県</option>
		<option value="09" {if $PrefCd == "09" }selected {/if}>栃木県</option>

		<option value="10" {if $PrefCd == "10" }selected {/if}>群馬県</option>
		<option value="11" {if $PrefCd == "11" }selected {/if}>埼玉県</option>
		<option value="12" {if $PrefCd == "12" }selected {/if}>千葉県</option>
		<option value="13" {if $PrefCd == "13" }selected {/if}>東京都</option>
		<option value="14" {if $PrefCd == "14" }selected {/if}>神奈川県</option>
		<option value="15" {if $PrefCd == "15" }selected {/if}>新潟県</option>
		<option value="16" {if $PrefCd == "16" }selected {/if}>富山県</option>
		<option value="17" {if $PrefCd == "17" }selected {/if}>石川県</option>
		<option value="18" {if $PrefCd == "18" }selected {/if}>福井県</option>
		<option value="19" {if $PrefCd == "19" }selected {/if}>山梨県</option>

		<option value="20" {if $PrefCd == "20" }selected {/if}>長野県</option>
		<option value="21" {if $PrefCd == "21" }selected {/if}>岐阜県</option>
		<option value="22" {if $PrefCd == "22" }selected {/if}>静岡県</option>
		<option value="23" {if $PrefCd == "23" }selected {/if}>愛知県</option>
		<option value="24" {if $PrefCd == "24" }selected {/if}>三重県</option>
		<option value="25" {if $PrefCd == "25" }selected {/if}>滋賀県</option>
		<option value="26" {if $PrefCd == "26" }selected {/if}>京都府</option>
		<option value="27" {if $PrefCd == "27" }selected {/if}>大阪府</option>
		<option value="28" {if $PrefCd == "28" }selected {/if}>兵庫県</option>
		<option value="29" {if $PrefCd == "29" }selected {/if}>奈良県</option>

		<option value="30" {if $PrefCd == "30" }selected {/if}>和歌山県</option>
		<option value="31" {if $PrefCd == "31" }selected {/if}>鳥取県</option>
		<option value="32" {if $PrefCd == "32" }selected {/if}>島根県</option>
		<option value="33" {if $PrefCd == "33" }selected {/if}>岡山県</option>
		<option value="34" {if $PrefCd == "34" }selected {/if}>広島県</option>
		<option value="35" {if $PrefCd == "35" }selected {/if}>山口県</option>
		<option value="36" {if $PrefCd == "36" }selected {/if}>徳島県</option>
		<option value="37" {if $PrefCd == "37" }selected {/if}>香川県</option>
		<option value="38" {if $PrefCd == "38" }selected {/if}>愛媛県</option>
		<option value="39" {if $PrefCd == "39" }selected {/if}>高知県</option>

		<option value="40" {if $PrefCd == "40" }selected {/if}>福岡県</option>
		<option value="41" {if $PrefCd == "41" }selected {/if}>佐賀県</option>
		<option value="42" {if $PrefCd == "42" }selected {/if}>長崎県</option>
		<option value="43" {if $PrefCd == "43" }selected {/if}>熊本県</option>
		<option value="44" {if $PrefCd == "44" }selected {/if}>大分県</option>
		<option value="45" {if $PrefCd == "45" }selected {/if}>宮崎県</option>
		<option value="46" {if $PrefCd == "46" }selected {/if}>鹿児島県</option>
		<option value="47" {if $PrefCd == "47" }selected {/if}>沖縄県</option>
	</select><br />
	<input type="text" name="Address" id="Address" maxlength="50" value="{$Address}" class="inputText" style="ime-mode:active;" />
</td>
</tr>
<tr>
<th>TEL</th><td><input type="text" name="Tel1" id="Tel1" maxlength="4" value="{$Tel1}" class="inputNum" style="ime-mode:disabled;" />&nbsp;-&nbsp;<input type="text" name="Tel2" id="Tel2" maxlength="4" value="{$Tel2}" class="inputNum" style="ime-mode:disabled;" />&nbsp;-&nbsp;<input type="text" name="Tel3" id="Tel3" maxlength="4" value="{$Tel3}" class="inputNum" style="ime-mode:disabled;" /></td>
</tr>
<tr>
<th>携帯</th><td><input type="text" name="Mobile1" id="Mobile1" maxlength="4" value="{$Mobile1}" class="inputNum" style="ime-mode:disabled;" />&nbsp;-&nbsp;<input type="text" name="Mobile2" id="Mobile2" maxlength="4" value="{$Mobile2}" class="inputNum" style="ime-mode:disabled;" />&nbsp;-&nbsp;<input type="text" name="Mobile3" id="Mobile3" maxlength="4" value="{$Mobile3}" class="inputNum" style="ime-mode:disabled;" /></td>
</tr>
<tr>
<th>連絡先TEL</th><td>※上記以外の連絡先がある場合、ご記入ください。<br /><input type="text" name="Contact1" id="Contact1" maxlength="4" value="{$Contact1}" class="inputNum" style="ime-mode:disabled;" />&nbsp;-&nbsp;<input type="text" name="Contact2" id="Contact2" maxlength="4" value="{$Contact2}" class="inputNum" style="ime-mode:disabled;" />&nbsp;-&nbsp;<input type="text" name="Contact3" id="Contact3" maxlength="4" value="{$Contact3}" class="inputNum" style="ime-mode:disabled;" /></td>
</tr>
<tr>
<th>メールアドレス</th><td><input type="text" name="Mail" id="Mail" maxlength="50" value="{$Mail}" class="inputText" style="ime-mode:disabled;" /></td>
</tr>
<tr>
<th>性別</th><td>&nbsp;<input type="radio" name="Sex" id="Sex0" value="0" disabled="false" />&nbsp;<label for="Sex0">男性</label>&nbsp;&nbsp;<input type="radio" name="Sex" id="Sex1" value="1" checked />&nbsp;<label for="Sex1">女性</label></td>
</tr>
<tr>
<th>生年月日</th><td>
	<select name="Year" id="Year" >
		<option value="1986" {if $Year == '1986'}selected{/if}>1986</option>
		<option value="1987" {if $Year == '1987'}selected{/if}>1987</option>
		<option value="1988" {if $Year == '1988'}selected{/if}>1988</option>
		<option value="1989" {if $Year == '1989'}selected{/if}>1989</option>
		<option value="1990" {if $Year == '1990'}selected{/if}>1990</option>
		<option value="1991" {if $Year == '1991'}selected{/if}>1991</option>
		<option value="1992" {if $Year == '1992'}selected{/if}>1992</option>
		<option value="1993" {if $Year == '1993'}selected{/if}>1993</option>
		<option value="1994" {if $Year == '1994'}selected{/if}>1994</option>
	</select>&nbsp;年&nbsp;&nbsp;
	<select name="Month" id="Month" >
		<option value="01" {if $Month == '01'}selected{/if}>01</option>
		<option value="02" {if $Month == '02'}selected{/if}>02</option>
		<option value="03" {if $Month == '03'}selected{/if}>03</option>
		<option value="04" {if $Month == '04'}selected{/if}>04</option>
		<option value="05" {if $Month == '05'}selected{/if}>05</option>
		<option value="06" {if $Month == '06'}selected{/if}>06</option>
		<option value="07" {if $Month == '07'}selected{/if}>07</option>
		<option value="08" {if $Month == '08'}selected{/if}>08</option>
		<option value="09" {if $Month == '09'}selected{/if}>09</option>
		<option value="10" {if $Month == '10'}selected{/if}>10</option>
		<option value="11" {if $Month == '11'}selected{/if}>11</option>
		<option value="12" {if $Month == '12'}selected{/if}>12</option>
	</select>&nbsp;月&nbsp;&nbsp;
	<select name="Day" id="Day" >
		<option value="01" {if $Day == '01'}selected{/if}>01</option>
		<option value="02" {if $Day == '02'}selected{/if}>02</option>
		<option value="03" {if $Day == '03'}selected{/if}>03</option>
		<option value="04" {if $Day == '04'}selected{/if}>04</option>
		<option value="05" {if $Day == '05'}selected{/if}>05</option>
		<option value="06" {if $Day == '06'}selected{/if}>06</option>
		<option value="07" {if $Day == '07'}selected{/if}>07</option>
		<option value="08" {if $Day == '08'}selected{/if}>08</option>
		<option value="09" {if $Day == '09'}selected{/if}>09</option>
		<option value="10" {if $Day == '10'}selected{/if}>10</option>
		<option value="11" {if $Day == '11'}selected{/if}>11</option>
		<option value="12" {if $Day == '12'}selected{/if}>12</option>
		<option value="13" {if $Day == '13'}selected{/if}>13</option>
		<option value="14" {if $Day == '14'}selected{/if}>14</option>
		<option value="15" {if $Day == '15'}selected{/if}>15</option>
		<option value="16" {if $Day == '16'}selected{/if}>16</option>
		<option value="17" {if $Day == '17'}selected{/if}>17</option>
		<option value="18" {if $Day == '18'}selected{/if}>18</option>
		<option value="19" {if $Day == '19'}selected{/if}>19</option>
		<option value="20" {if $Day == '20'}selected{/if}>20</option>
		<option value="21" {if $Day == '21'}selected{/if}>21</option>
		<option value="22" {if $Day == '22'}selected{/if}>22</option>
		<option value="23" {if $Day == '23'}selected{/if}>23</option>
		<option value="24" {if $Day == '24'}selected{/if}>24</option>
		<option value="25" {if $Day == '25'}selected{/if}>25</option>
		<option value="26" {if $Day == '26'}selected{/if}>26</option>
		<option value="27" {if $Day == '27'}selected{/if}>27</option>
		<option value="28" {if $Day == '28'}selected{/if}>28</option>
		<option value="29" {if $Day == '29'}selected{/if}>29</option>
		<option value="30" {if $Day == '30'}selected{/if}>30</option>
		<option value="31" {if $Day == '31'}selected{/if}>31</option>
	</select>&nbsp;日
</td>
</tr>
<tr>
<th>血液型</th><td>
	<select name="Blood" id="Blood" >
		<option value="0" {if $Blood == '0'}selected{/if}>不明</option>
		<option value="1" {if $Blood == '1'}selected{/if}>A</option>
		<option value="2" {if $Blood == '2'}selected{/if}>B</option>
		<option value="3" {if $Blood == '3'}selected{/if}>O</option>
		<option value="4" {if $Blood == '4'}selected{/if}>AB</option>
	</select>
</td>
</tr>
<tr>
<th>サイズ</th><td>&nbsp;
	身長&nbsp;<input type="text" name="Height" id="Height" maxlength="5" value="{$Height}" class="inputNum" style="ime-mode:disabled;" />&nbsp;cm&nbsp;&nbsp;
	体重&nbsp;<input type="text" name="Weight" id="Weight" maxlength="4" value="{$Weight}" class="inputNum" style="ime-mode:disabled;" />&nbsp;kg<br />
	バスト&nbsp;<input type="text" name="Breast" id="Breast" maxlength="5" value="{$Breast}" class="inputNum" style="ime-mode:disabled;" />&nbsp;cm&nbsp;&nbsp;
	ウエスト&nbsp;<input type="text" name="Waist" id="Waist" maxlength="4" value="{$Waist}" class="inputNum" style="ime-mode:disabled;" />&nbsp;cm&nbsp;&nbsp;
	ヒップ&nbsp;<input type="text" name="Hip" id="Hip" maxlength="5" value="{$Hip}" class="inputNum" style="ime-mode:disabled;" />&nbsp;cm&nbsp;&nbsp;
	靴のサイズ&nbsp;<input type="text" name="Foot" id="Foot" maxlength="4" value="{$Foot}" class="inputNum" style="ime-mode:disabled;" />&nbsp;cm
</td>
</tr>
<tr>
<th>最終学歴</th><td>(例)2012年3月&nbsp;○○大学卒業<br /><textarea name="Academic" id="Academic" cols="80" rows="2" maxlength="500">{$Academic}</textarea></td>
</tr>
<tr>
<th>職歴・芸歴</th><td>(芸能に関するレッスン・TV・舞台・モデルetcの経験)<br />
	<textarea name="Career" id="Career" cols="80" rows="2" maxlength="500">{$Career}</textarea><br /><br />
	今現在、モデル事務所もしくはイベントコンパニオン事務所等に登録していますか？<br />
	<input type="radio" name="Entry" id="Entry1" value="1" {if $Entry == '1'}checked{/if} />&nbsp;<label for="Entry1">している</label>&nbsp;&nbsp;事務所名&nbsp;<input type="text" name="Office" id="Office" maxlength="50" value="{$Office}" class="inputText" style="ime-mode:active;" /><br />
	<input type="radio" name="Entry" id="Entry0" value="0" {if $Entry == '0'}checked{/if} />&nbsp;<label for="Entry0">していない</label>
</td>
</tr>
<tr>
<th>趣味・特技</th><td><input type="text" name="HobbySkill" id="HobbySkill" maxlength="100" value="{$HobbySkill}" class="inputText2" style="ime-mode:active;" /></td>
</tr>
<tr>
<th>長所・短所</th><td><input type="text" name="StWkPoint" id="StWkPoint" maxlength="100" value="{$StWkPoint}" class="inputText2" style="ime-mode:active;" /></td>
</tr>
<tr>
<th>尊敬する人</th><td><input type="text" name="Respect" id="Respect" maxlength="100" value="{$Respect}" class="inputText2" style="ime-mode:active;" /></td>
</tr>
<tr>
<th>最近、興味がある事</th><td><input type="text" name="Interest" id="Interest" maxlength="100" value="{$Interest}" class="inputText2" style="ime-mode:active;" /></td>
</tr>
<tr>
<th>志望動機</th><td><textarea name="Reason" id="Reason" cols="80" rows="2" maxlength="500">{$Reason}</textarea></td>
</tr>
<tr>
<th>自己PR</th><td><textarea name="Pr" id="Pr" cols="80" rows="2" maxlength="500">{$Pr}</textarea></td>
</tr>
<tr>
<th>写真</th><td>3ヶ月以内に撮影した、はっきりと写っている1メガバイト以内の写真を送信してください。<br />
	<input type="hidden" name="MAX_FILE_SIZE" value="1048576" />
	<span style="line-height:30px;">上半身写真&nbsp;<input type="file" name="Photo1" id="Photo1" size="30" accept="image/jpg,image/jpeg,image/png,image/gif" /></span>{if $PhotoName1 <> ''}&nbsp;({$PhotoName1}){/if}<br />
	<input type="hidden" name="PhotoName1" id="PhotoName1" value="{$PhotoName1}" /><input type="hidden" name="PhotoPath1" id="PhotoPath1" value="{$PhotoPath1}" />
	<span style="line-height:20px;">全身写真&nbsp;<input type="file" name="Photo2" id="Photo2" size="30" accept="image/jpg,image/jpeg,image/png,image/gif" /></span>{if $PhotoName2 <> ''}&nbsp;({$PhotoName2}){/if} 
	<input type="hidden" name="PhotoName2" id="PhotoName2" value="{$PhotoName2}" /><input type="hidden" name="PhotoPath2" id="PhotoPath2" value="{$PhotoPath2}" />
</td>
</tr>
</table>

<br />
▼必ずお読みください。
<div class="privacyTitle">
	<p class="txt">個人情報の取り扱いについて</p>
</div>
<div class="privacyContents">
	<iframe width="100%" scrolling="auto" height="165" frameborder="no" src="/app/html/inquiry/privacy.html" id="privacy"></iframe><br />
</div>
<br />

<div class="entryBotton">
<input type="image" name="Submit" id="Submit" src="/images/inquiry/hp/form/btn_input_confirm_02.jpg" alt="「個人情報の取り扱いについて」に同意の上入力内容を確認" width="271" height="66" onclick="submit(); return false;" />
</div>

</form>
</div><!--/txtListBox-->
</div><!--/paragraphBox-->


</div><!--/mainLeft-->
